A brain tumour is the abnormal growth of mass tissue in the brain and there are more than 120 types of brain tumors. They can be classified as benign (non-cancerous), malignant, primary, and metastatic (secondary).
- Benign tumours – Also known as non-cancerous tumors, they arise from cells within or around the brain and expand slowly. They usually have clear borders and do not spread to other tissue. Most of these tumors have a tendency to press on surrounding brain tissue and nerves.
- Malignant tumours consist of cancer cells and they grow rapidly. The borders are not clear and may invade or spread to other brain tissue areas.
- Primary tumours begin in cells of the brain and may invade other areas of the brain and spine.
- Metastatic (secondary) tumours start in another area of the body and invade the brain. Secondary brain tumours are more common as compared to primary brain tumours.
Types of brain tumours
Benign brain tumours examples
- Glomus jugulare
- Pituitary adenomas, etc.
Malignant brain tumours
- Glioblastoma multiforme
Other types of brain tumours
- Rhabdoid tumour
- CNS lymphoma
Common brain tumors in children include:
- Brain stem glioma
- Optic Nerve Glioma
- Pineal Tumour
- Primitive Neuroectodermal Tumours
- Rhabdoid Tumour
- Juvenile Pilocytic Astrocytoma
Prevalence in India
The occurrence of brain tumours in India is from 5 to 10 per 100,000 population with 2% being malignant. The most common tumours are astrocytoma (47.3%), medulloblastoma (11.4%), craniopharyngioma (9.7%), ependymal tumours (4.8%), and nerve sheath tumours (4.1%).
There are many risk factors associated with a brain tumour.
- Age: Brain cancer can occur at any age but it is more prevalent in children and older adults.
- Gender: Men are more prone to develop brain cancer than women.
- Family history: About 5% of brain cancers are due to genetic factors.
- Race and ethnicity: Some brain cancers such as gliomas are more prevalent in black people. Northern European people and Japanese are two times more likely to have brain cancer. There is still a paucity of literature regarding the distribution of brain tumors in India
- Home and work exposures: Exposing to products such as pesticides, solvents, vinyl chloride, oil products, and rubber may cause an increased risk of developing brain cancer but no scientific evidence has been found yet.
- Infections: Exposure to infections such as Epstein-Barr virus may increase the risk of developing CNS lymphoma.
- Head injury: some studies have shown a relationship between serious head injury and brain tumors especially meningiomas, however, there is still a lack of sufficient evidence to directly link head injury with the occurrence of brain tumor.
- Ionizing radiation: Any previous treatment to the brain or body with ionizing radiation has been linked to developing brain tumors.
- Electromagnetic fields: The use of cell phones and power lines has shown no relationship to developing brain tumors in adults. But the World Health Organization (WHO) advises to limit the use of cell phones and use hands-free headsets for adults and children.
Signs and symptoms
The signs and symptoms of brain tumours vary depending on the type of brain tumour and its location.
- Recurrent headaches: headaches worsen with activity or early morning
- Sleep difficulty
- Changes in memory
- Poor coordination - changes in walking and daily activities
- Difficulty speaking or comprehending
- Vision problem
- Personality change
- Muscle weakness or paralysis
- Changes in speech, hearing, and emotional state
The treatment of a brain tumour depends on the type, size, and grade of the tumour.
Various treatment options include surgery, chemotherapy, radiation, and targeted therapy.
- Surgery: It is usually the first treatment for brain tumours. Aim of surgery is to remove the tumor completely or as much as possible safely and to provide tumor tissue for an exact diagnosis. With advancements in technology like navigation guidance, latest microscopes, endoscopes, etc. and increasing expertise surgery has become a very safe and effective modality for treating brain tumors
- Radiation therapy: using high energy x-rays to destroy brain cancer cells. The most common type of radiation therapy used is external-beam radiation therapy. Radiotherapy is commonly used after surgery for malignant tumors and in some cases recurrent benign tumors
- Radio Surgery: One or two sittings of precisely focused radiation to the tumor tissue to control or cure the tumor. Mainly used in smaller tumors. Examples are Gamma Knife and Linac
- Chemotherapy: Using drugs to kill brain cancer cells. Usually given in chemo-sensitive tumors, radioresistant tumors, in combination with RT or in children below 3 years of age where radiotherapy is contraindicated. It is also possible give intra-tumoral chemotherapy ( e.g. Carmustine wafers) in malignant brain tumors during surgery to increase tumor control rate
- Targeted therapy: used for targeting cancer’s genes and proteins, or the tissue environment.
- Palliative treatment: includes nutritional changes, medications, relaxation techniques, and providing emotional and spiritual support. Some medications include corticosteroids and anti-seizure drugs.
- Manipal Hospitals, Dwarka offers brain tumor surgery in Delhi which include radiation therapy, chemotherapy, and targeted drug therapy. The brain tumor specialist in Delhi are experts in awake brain surgery.
Frequently Asked Questions
1. How is a brain tumour diagnosed?
After obtaining a medical history and performing a physical examination, the doctor would recommend some tests. Generally, magnetic resonance imaging (MRI) helps to detect a brain tumour. After an MRI, the best way to know the type of tumour is to obtain tissue from biopsy or surgery.
2. What are the prognostic factors of a brain tumour?
There are various prognostic factors of brain tumours. Prognostic factors include age, symptoms, tumour location, cancer spread, and recurrence. These factors help to establish brain cancer treatment and a patient’s prognosis.
3. What are the side effects of treatment?
Radiation therapy short-term side effects include hair loss, fatigue, upset stomach, and skin reactions. Chemotherapy side effects include nausea, vomiting, hair loss, fatigue, and appetite loss. Most side effects go away post-treatment.
4. What is the survival rate after been diagnosed with a brain tumour?
The survival rate depends on many factors such as the type of cancer. Complete removal of a benign tumor can insure normal life expectancy. Survival rates decline with primary malignant and metastatic brain tumors.
5. Can brain tumours recur?
Brain tumours can recur. Imaging tests are done during follow-up. Some required tests depend on the type and grade of cancer.
Dr. Anurag Saxena
HOD & Consultant - Department Of Neurosurgery
Manipal Hospitals, Dwarka, Delhi